EARLY SONOGRAPHIC EVALUATION OF THE TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)

The purpose of this study was to evaluate duplex and color Doppler fin dings in patients before and within 24 h after transjugular intrahepat ic portosystemic shunts (TIPS). Conventional duplex and color Doppler were used in the assessment of 19 patients who underwent TIPS as part of a prospective protocol. Patients were examined within 24 h before a nd after the procedure. Before TIPS, patency, flow direction, and peak flow velocity in the main portal vein and hepatic artery were studied , as well as patency and flow direction in hepatic veins, splenic vein , and inferior vena cava (IVC). Immediately after the procedure, sonog raphic identification of stent position, shunt patency, and flow dynam ics were evaluated and patency and flow direction of hepatic veins, sp lenic vein, and IVC were determined. The portogram performed at the en d of the procedure was compared with the 24-h sonographic studies afte r TIPS to determine sonographic/angiographic correlation. No intrapare nchymal abnormalities or perihepatic fluid collections were detected a fter the procedure. The metallic stent was clearly seen in all patient s. Mean peak shunt flow velocities were 139 +/- 50 cm/sec within 24 h after TIPS. Absence of flow through the shunt was correctly identified in one case and confirmed angiographically. Mean peak flow velocity i n the portal vein before TIPS was 22 +/- 13.6 cm/sec and increased to 43.6 +/- 9.1 cm/sec after TIPS (p < 0.05). The hepatic artery peak sys tolic velocity increased from 77 +/-51 cm/sec before TIPS to 119 +/- 5 3 cm/sec after the procedure (p = 0.029). Conventional duplex and colo r Doppler ultrasound proved to be a useful noninvasive diagnostic meth od to assess patients who have undergone TIPS. We propose its use as t he primary diagnostic modality in these patients.